Provider Demographics
NPI:1205474558
Name:RORVIK, AMANDA RAE (ND)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:RORVIK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1823
Mailing Address - Country:US
Mailing Address - Phone:253-441-5914
Mailing Address - Fax:
Practice Address - Street 1:711 COURT A STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5227
Practice Address - Country:US
Practice Address - Phone:253-503-8792
Practice Address - Fax:253-503-8791
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61008161175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath